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To Love or to Pay: Savings and Health Care in Older Age

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  • Loretti I. Dobrescu

Abstract

This paper develops a dynamic structural lifecycle model to study how heterogeneous health and medical spending shocks affect the savings behavior of the elderly. Individuals are allowed to respond to health shocks in two ways: They can directly pay for their health care expenses (self-insure) or they can rely on health insurance contracts. There are two possible insurance options, one through formal contracts and another through informal care provided by family. Formal contracts may be affected by asymmetric information problems whereas informal insurance depends on social ties (cohesion) and on bequeathable wealth. I estimate the model on SHARE data using simulated method of moments for four levels of wealth in a sample of single retired Europeans. Counterfactual experiments show that health, medical spending, and health insurance are indeed the main drivers of the slow wealth decumulation in old age. I also find that social cohesion rises with age, declines with wealth, and is higher in Mediterranean countries than in Central European and Scandinavian countries. Finally, high social cohesion appears typically associated with increased life expectancy.

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  • Loretti I. Dobrescu, 2015. "To Love or to Pay: Savings and Health Care in Older Age," Journal of Human Resources, University of Wisconsin Press, vol. 50(1), pages 254-299.
    • Handle: RePEc:uwp:jhriss:v:50:y:2015:i:1:p:254-299
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    Cited by:

    1. Liu, Xiao & Burge, Gregory S., 2024. "The effect of the new cooperative medical scheme on rural labor supply in China," China Economic Review, Elsevier, vol. 85(C).
    2. Amengual, D.; Bueren, J.; Crego, J.A.;, 2017. "Endogenous Health Groups and Heterogeneous Dynamics of the Elderly," Health, Econometrics and Data Group (HEDG) Working Papers 17/18, HEDG, c/o Department of Economics, University of York.
    3. Eric French & John Bailey Jones & Elaine Kelly & Jeremy McCauley, 2018. "End-of-Life Medical Expenses," Working Paper 18-18, Federal Reserve Bank of Richmond.
    4. Giordana, Gastón A. & Pi Alperin, María Noel, 2023. "Old age takes its toll: Long-run projections of health-related public expenditure in Luxembourg," Economics & Human Biology, Elsevier, vol. 50(C).
    5. Luigi Ventura & Charles Yuji Horioka, 2020. "The wealth decumulation behavior of the retired elderly in Italy: the importance of bequest motives and precautionary saving," Review of Economics of the Household, Springer, vol. 18(3), pages 575-597, September.
    6. Dobrescu, Isabella & Faravelli, Marco & Megalokonomou, Rigissa & Motta, Alberto, 2019. "Rank Incentives and Social Learning: Evidence from a Randomized Controlled Trial," IZA Discussion Papers 12437, Institute of Labor Economics (IZA).
    7. Dante Amengual & Jesús Bueren & Julio A. Crego, 2021. "Endogenous health groups and heterogeneous dynamics of the elderly," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 36(7), pages 878-897, November.
    8. Niimi, Yoko & Horioka, Charles Yuji, 2019. "The wealth decumulation behavior of the retired elderly in Japan: The relative importance of precautionary saving and bequest motives," Journal of the Japanese and International Economies, Elsevier, vol. 51(C), pages 52-63.
    9. Edouard Augustin Ribes, 2021. "How does education influence individuals' use of bequests as a long-term care insurance?," Working Papers hal-03498481, HAL.
    10. Max Groneck, 2017. "Bequests and Informal Long-Term Care: Evidence from HRS Exit Interviews," Journal of Human Resources, University of Wisconsin Press, vol. 52(2), pages 531-572.
    11. Edouard Augustin Ribes, 2023. "Transforming personal finance thanks to artificial intelligence: myth or reality?," Financial Economics Letters, Anser Press, vol. 2(1), pages 11-12, April.
    12. Holzmann, Robert & Ayuso, Mercedes & Alaminos, Estefanía & Bravo, Jorge Miguel, 2019. "Life Cycle Saving and Dissaving Revisited across Three-Tiered Income Groups: Starting Hypotheses, Refinement through Literature Review, and Ideas for Empirical Testing," IZA Discussion Papers 12655, Institute of Labor Economics (IZA).
    13. Daniel Barczyk & Sean Fahle & Matthias Kredler, 2023. "Save, Spend, or Give? A Model of Housing, Family Insurance, and Savings in Old Age," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 90(5), pages 2116-2187.
    14. Attanasio, O. & Bonfatti, A. & Kitao, S. & Weber, G., 2016. "Global Demographic Trends," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 179-235, Elsevier.
    15. Edouard Ribes, 2022. "Transforming personal finance thanks to artificial intelligence: myth or reality?," Working Papers hal-03862261, HAL.
    16. Dobrescu, L.I. & Smith, J.P., 2016. "The HRS Around the World Surveys," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 993-1018, Elsevier.
    17. Jesus Bueren, 2023. "Long-Term Care Needs and Savings in Retirement," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 49, pages 201-224, July.

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    More about this item

    JEL classification:

    • D1 - Microeconomics - - Household Behavior
    • D31 - Microeconomics - - Distribution - - - Personal Income and Wealth Distribution
    • E27 - Macroeconomics and Monetary Economics - - Consumption, Saving, Production, Employment, and Investment - - - Forecasting and Simulation: Models and Applications
    • H31 - Public Economics - - Fiscal Policies and Behavior of Economic Agents - - - Household
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I1 - Health, Education, and Welfare - - Health

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